- R1 RCM (Boise, ID)
- …sophisticated analytics, AI, intelligent automation, and workflow orchestration. As our ** Clinical Appeals Supervisor** , you will help support clinicians ... position. **Here's what you will experience working as a Clinical Appeals Supervisor:** + Track and monitor...for additional support and engagement. **Required Skills:** + Active Registered Nurse license For this US-based position,… more
- Molina Healthcare (GA)
- … decisions for appeals outcomes within compliance standards. **KNOWLEDGE/SKILLS/ABILITIES** + The Clinical Appeals Nurse ( RN ) performs clinical ... **JOB DESCRIPTION** For this position we are seeking a ( RN ) Registered Nurse who must...with internet connectivity of high speed required **Job Summary** Clinical Appeals is responsible for making appropriate… more
- Centene Corporation (Columbia, SC)
- …analyze and report verbal and written information regarding member and provider clinical appeals , including information follow up + Prepare response letters ... for member and provider clinical appeals and ensure letters are compliant...all policies and standards Must reside in SC **Education/Experience:** RN with 4+ years of clinical nursing… more
- Mayo Clinic (Rochester, MN)
- …Financial Management Association (HFMA) Certification Preferred. **Preferred Qualifications:** + Current Registered Nurse ( RN ) license in the United ... required as assignments warrant. **Position Overview** The Director of Clinical Appeals will serve as a strategic...Mayo Clinic locations. + Manage a high-performing team of nurse reviewers, clinical appeal writers, and support… more
- St. Luke's University Health Network (Allentown, PA)
- …we serve, regardless of a patient's ability to pay for health care. The RN Clinical Review Appeals Specialist retrospectively reviews patient medical ... Works inside with adequate lighting, comfortable temperature and ventilation. EDUCATION: Registered Nurse required, BSN preferred. Current license required. .… more
- TEKsystems (Annapolis, MD)
- The Clinical Denials Appeals Specialist plays a...case management, denials, or billing + Must be a Registered Nurse or Licensed Nurse ... clinical denials, determine appropriate next steps, and lead appeals efforts by analyzing medical necessity, addressing authorization issues, and resolving… more
- Henry Ford Health System (Troy, MI)
- … Director, Appeals and Grievance. Education and Experience Required: + Registered Nurse with current Michigan licensure. + Bachelor's Degree in Healthcare, ... General Summary: The Clinical Manager, Medical Appeals supports appeals team members to plan, direct, evaluate, coordinate, and manage the activities… more
- Emory Healthcare/Emory University (Atlanta, GA)
- …the direction of the **Utilization Management Appeals Professional, Registered Nurse ** is responsible for managing clinical denials and appeals . + ... **MINIMUM QUALIFICATIONS** : + License - Must have a valid, active unencumbered Registered Nurse license or temporary permit approved by the Georgia Licensing… more
- Catholic Health Services (Melville, NY)
- …Health was named Long Island's Top Workplace! Job Details The Utilization and Appeals Manager (UAM) proactively conducts clinical reviews and appeals ... Responsibilities include but not limited to: Receives, manages and provides clinical reviews and/or submissions as required by contractual or regulatory… more
- Evolent (Montgomery, AL)
- …to Standard processing, documenting accordingly. + Works closely with the appeals -dedicated Clinical Reviewers to ensure timely adjudication of processed ... culture. **What You'll Be Doing:** Job Description The Specialty Appeals Team offers candidates the opportunity to make a...and Preferred:** + 1-3 years' experience and as an RN - **Required** + Minimum of 5 years in… more
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